title: Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes.
abstract: OBJECTIVE
  To explore older patients' perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management.
  
  
  METHODS
  We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes.
  
  
  RESULTS
  We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens.
  
  
  CONCLUSIONS
  Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients' outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.
authors.affiliation: The Pennsylvania State University, University Park, PA, USA. elizabeth.beverly@joslin.harvard.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Beverly
authors.forename: L A
authors.initials: LA
authors.lastname: Wray
authors.forename: C J
authors.initials: CJ
authors.lastname: Chiu
authors.forename: K
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000451:nursing; D005260:Female; D017144:Focus Groups; D006442:Glycated Hemoglobin; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D012648:Self Care / Q000592:standards / Q000706:statistics & numerical data*
chemical_list: D006442:Glycated Hemoglobin